一位乳癌末期合併骨轉移病人之護理經驗

Nursing Experience of a Terminal-Stage Breast Cancer Patient with Bone Metastasis

本文為照顧一位乳癌合併骨轉移患者，因面臨嚴重疼痛與末期骨轉移而引發重度死亡焦慮與營養失衡問題之護理經驗。筆者護理期間為2023年1月9日至1月31日，運用Gordon十一項健康功能型態評估架構，藉由觀察、傾聽、會談、身體評估及電子病歷查閱等方式進行資料收集，確立個案有急性疼痛、營養失衡：少於身體所需、死亡焦慮等主要護理問題。照護過程藉由持續性關懷、家人陪伴及宗教支持，鼓勵個案表達內心感受，釋放憂傷及害怕情緒，結合安寧緩和專業團隊的介入，教導家屬以輕音樂、調整舒適姿勢、採用薰衣草精油按摩及教導放鬆技巧等非藥物措施，緩解疼痛症狀與減輕焦慮。此外，針對營養失衡：少於身體所需問題，選擇高營養食物及癌末專用飲品、以少量多餐及細嚼慢嚥等方式，營造放鬆的環境，提升進食意願，改善營養狀況。建議臨床教育應加強護理人員在安寧療護的溝通技巧，透過情境模擬教學、角色扮演活動及案例討論等多元教學方式，提升護理人員靈性照護的能力，結合跨專業團隊資源及家庭支持力量，可有效提高癌症末期患者的生活品質，並增強其在病程末期的尊嚴與安適感。

This article describes a nursing care experience of a patient with breast cancer and bone metastasis experiencing severe pain, marked death anxiety, and nutritional imbalance in the terminal stage. The care period lasted from January 9 to January 31, 2023. Data were collected through observation, active listening, interview, physical assessment, and electronic medical record review, based on Gordon's 11 Functional Health Patterns Assessment framework. The identified nursing problems included acute pain, imbalanced nutrition: less than body requirements, and death anxiety. During the care process, continuous emotional support, family companionship, and religious support were provided to encourage the patient to express inner feelings and relieve grief and fear. In collaboration with the palliative care team, non-pharmacological interventions, such as lavender essential oil massage and relaxation technique, were implemented to alleviate pain and reduce anxiety. To address imbalanced nutrition: less than body requirements, high-nutrition foods and specialized nutritional drinks were provided. Strategies such as small, frequent meals and thorough chewing were implemented in a relaxed dining environment to enhance the patient's willingness to eat and improve nutritional status. It is recommended that clinical education strengthen nurses' communication skills in palliative care. Multimodal teaching strategies, including scenario-based simulations, role-playing activities, and case discussions, should be utilized to enhance nurses' ability to provide spiritual care. By integrating interdisciplinary team resources and family support, the quality of life of terminal cancer patients may be improved significantly, enhancing dignity and comfort during the end-of-life stage.